The stage distribution for wearing sunscreen of at least SPF30 on exposed skin and reapplying frequently when working outdoors in the summer is shown in Table 2
. The results that follow therefore reflect differences between those within the early inaction stages and primarily those at the maintenance stage within the action stages.
3.1.1. Behavioral Beliefs
Attitudes towards sunscreen centered on two themes—beliefs about the risk of skin cancer presented by both UK climate and personal characteristics, particularly skin type. Beliefs were largely stage-specific, with those in the earlier stages of change holding the view that the temperate UK climate does not present a risk of burning, precluding a need for sunscreen, “We never get enough hot days and I’ve just never done it [used sunscreen] while working” (contemplation); “It would need over a couple of weeks at least before I would notice my skin darkening, by that stage it usually starts to rain again” (precontemplation). In contrast, those in the action stages held that, although sun exposure is intermittent in the UK, the potential risk remains high, “I always use it [sunscreen] because ultraviolet here in Britain’s just as strong as anywhere in Europe when the sun’s out” (maintenance). Similarly, “Over here you don’t think that you get burnt, but you do. Over here, you think we can just go out there in the sun. We’re not used to it, but I have started doing it because it has been really warm here and we are not used to it” (action).
A distinction was evident across the stages of change for attitudes towards the need for sunscreen based on personal characteristics. Those in the inaction stages tended to perceive themselves being at low risk due to personal characteristics such as skin type, “Even on holiday I rarely use sun cream, because I don’t burn. I just go brown, so you sort of don’t need to [use sunscreen]” (precontemplation); “I’m just fortunate enough to not really burn in that kind of weather, so I can get away with it” (contemplation); and to a lesser extent, hair coverage, “My arms are quite hairy so it takes me a long time to get a sun tan” (precontemplation).
Those in the action stages were more likely to acknowledge the higher risk associated with their skin type, often citing previous experiences of sunburn as a motivating factor, “I always plaster myself in it. I burn easily and have learned the hard way” (maintenance); “I get quite badly burned on the face so I use factor 50 on my face no matter what” (maintenance), with some noting the implications of sun burn for work ability, “After a burn it’s hard to walk, you don’t want to work, you are dehydrated, it’s just something you don’t want to go through again” (maintenance).
It was not uncommon for those in the action stages to indicate that sunscreen use was motivated by personal or family and friends’ experiences of skin cancer, “The reason I do it is that my mum had skin cancer on her face, so that is something I’m mindful of. Although I wouldn’t necessarily burn in the sun here, she wouldn’t either and she had darker skin than me” (maintenance). Similarly, “I had skin cancer last year so I would, I absolutely must now [use sunscreen]” (maintenance). Notably, some in the inaction stages indicated that a health scare might motivate them to change their attitude towards sunscreen.
Unrelated health scares were also identified as stimulating a positive attitude towards sunscreen use. For instance, one interviewee who reported always using sunscreen stated, “As you get a bit older you need to look after your health a bit more, there’s no excuses to say you didn’t know. I have had a recent health scare with my heart which has changed my outlook and made me make lifestyle changes” (maintenance).
3.1.2. Normative Beliefs
Two themes were identified for subjective norms influencing sunscreen use—the influence of colleagues and the beliefs about the employer’s expectations. Irrespective of stage it was considered rare to see colleagues applying sunscreen in the workplace, “I’ve never seen any of the boys with it” (maintenance); “I do, but I think there’s a lot that wouldn’t, I don’t see an awful lot of people putting it on to be honest” (maintenance). There was an assumption that colleagues probably used sunscreen but applied it surreptitiously, “I personally don’t see anyone putting it on, unless they put it on before they come to work, but I don’t actually ever see anyone applying it before going out on a walk. I’ve never seen a postman putting on sunscreen” (maintenance). Some interviewees in the inaction stages acknowledged having observed colleagues apply sunscreen but felt that they did not need to use it due to having a lower risk skin type, “The boys in there, their vans are full of it. Especially the lighter skinned boys, they will always have it with them” (precontemplation). In the same way, “I know two or three do put it on when they’re out you know, those that burn” (precontemplation).
Some participants observed that it was typically younger colleagues that used sunscreen: “I would say I’m aware of it, because I see others put theirs on, particularly the younger ones” (precontemplation). In line with this, some younger participants observed that older workers were less likely to use sunscreen: “There is a guy here who will wind me up [tease, make fun of me] about putting sunscreen on. He is an older guy” (maintenance).
The employer was identified as an advocate for sunscreen yet disinclined to enforce its application, preferring to leave utilization decisions to individuals, “We get told what they sort of recommend because of the sun on hot days but again it’s down to each individual if they choose not to do anything” (maintenance). Across the stages of change, participants held the view that RMG would not enforce sunscreen application, “We get the team briefings and they will say to you, ‘put on sunscreen’, but they don’t force you, it’s a personal preference” (maintenance). Several participants expressed views on the notion of RMG providing sunscreen. The majority across the stages reported being in favor of this, noting that, if provided, they would in all likelihood use it as there was some indication its use was encouraged, “I think the boss saying ‘there’s the sun cream, feel free to apply it’, people would go and apply it. If it wasn’t mentioned people wouldn’t always necessarily think about doing that” (maintenance). Similarly, “I think if it were [provided] in work and you come to work and it was red hot, I think folk would put it on” (contemplation).
The possibility of sunscreen use being enforced was roundly thought highly unlikely: “[if compulsory] you’d have to do it then wouldn’t you, but I can’t ever see it being compulsory” (precontemplation). Several participants thought it unlikely that RMG would provide sunscreen because of the allergy risk, “They won’t provide it because you could be allergic to different types of sun cream, so you have to provide your own” (maintenance), while others noted that they would prefer to have choice in product selection, “I think if I was going to put sunscreen on my body I’d choose it myself” (maintenance).
3.1.3. Control Beliefs
Ability to control the application of sunscreen was identified as an important influence on its use. Those in the inaction stages perceived sunscreen to be difficult to use owing to the inconvenience of carrying a bottle when on delivery rounds, “With everything I’m carrying I just think it’s too much to be carrying around all of the time” (contemplation). In contrast, those in the action stages reported no such difficulties, “I just have it in my kit bag. It is always there and I slap it on, factor 50” (maintenance). Similarly, “There aren’t really reasons you couldn’t do it. You should have it in the van” (maintenance).
Some in the inaction stages felt that sunscreen application was difficult, while those in the action stages indicated no such difficulties, tending to apply it prior to leaving home, “It’s easy, I just stick it on in the morning before I come out” (action). Reapplication was viewed as more difficult across the stages owing to sweat, “As for reapplying, when you’ve got a film of sweat it’s very difficult to slap all that on top, and the odds of it drying would be slim as well” (maintenance) and the likelihood of forgetting to take sunscreen out on a delivery round, “I would reapply it unless I forgot to bring it on my round” (maintenance). Those in the action stages whose delivery route involved use of a van reported that reapplication posed no difficulties, “It’s easy, when you take your next bag out of the back of the van you put some on” (maintenance).
Control beliefs were linked to perceived availability, with some indicating that, if sunscreen were on hand, they would apply it, “If someone handed it to me I might [use it] but I would never, I mean, I don’t think I have ever bought a bottle, I just use others’” (precontemplation), while some noted that control was linked to remembering to bring sunscreen to work, “There’s times when you leave the house and forget it” (maintenance).
Interestingly, when reflecting on their failure to use sunscreen at work, many interviewees in the inaction stages observed that they would use it when holidaying abroad and were fastidious when applying it to their children, “I have children and every time it’s sunny they get doused in sun cream, so I suppose I should start doing it myself really…(laughs)” (contemplation).
3.2. Wide-Brimmed Hat
The stage of change distribution for wearing a wide brimmed hat when working outdoors in the summer contrasted sharply with that for sunscreen, with all but one participant being in the inaction stages (Table 3
). The results that follow therefore focus on the early inaction stages of change and primarily those who have not considered adopting the sun safety practice.
3.2.1. Behavioral Beliefs
Attitudes towards wearing a wide brimmed hat were decidedly negative, with views primarily driven by concerns about appearance, “Those are ridiculous. They look stupid. I wouldn’t go out with that on” (precontemplation); “They are silly looking. I wouldn’t even think of wearing it” (precontemplation). Interviewees acknowledged awareness of potential benefits afforded by a wide brimmed hat while expressing resistance to the idea of wearing one, “I would definitely not [do that]. It looks stupid. I could see the benefits of it, but no, I wouldn’t do that. I don’t think the best design team in the world could come up with one that would look good” (precontemplation); “I wouldn’t wear one. That would just be fashion sense to me. It’s probably the right thing to do but I wouldn’t wear that” (precontemplation); “I’m sure it would benefit me, maybe your neck and stuff, stop it getting burnt, but I wouldn’t wear one” (precontemplation).
Some believed that a wide brimmed hat would make them the butt of jokes, “It doesn’t look good. And you’ll find, being in … [location] … people here have a particular sense of humor and some of the customers will make fun of you” (contemplation); “When we are walking around the student areas, if we were walking around the streets with one of those wide brimmed hats on we would get slated” (precontemplation). While concern regarding reactions from the public centered primarily on being the target of jokes, some felt that wearing a wide brimmed hat might make them the recipient of abuse, “In the area where I deliver it’s like painting a target on your back, it really is” (precontemplation); “On the walks you can get abuse from some people and wearing that hat might get you some comments” (contemplation).
Many in the inaction stages indicated that their negative attitude was determined by the UK climate and might be different if they lived elsewhere. In this regard, numerous participants referred to a proactive Australian sun safety culture and contrasted this to the UK, “We don’t really have the climate for it; somewhere like Australia or somewhere that gets strong sun, they have respect for the sun and they’re told from a young age ‘go out with a hat, with sunscreen, with a long-sleeved shirt to keep the sun off’. Here we just go ‘it’s wet, it’s cold, where’s my hat?’” (precontemplation). Australian sun safety culture was deemed responsible for making wide brimmed hats acceptable in that context, while remaining firmly unfashionable in the UK, “There is nothing wrong with the design from a safety perspective, it is just how it looks. I think in somewhere like Australia no one would raise an eyebrow, but here I think it is off putting. Our society isn’t geared up for that sort of thing” (contemplation). Similarly, “Australian postmen, you could sell a load to them. They’re more used to the sun so they would be more used to wearing hats like that” (precontemplation).
In relation to both appearance and climate, some participants noted that a baseball-style cap offered a compromise in the sense of affording some coverage to the face and the top of the head while permitting a degree of sun exposure on rare sunny days, “It is just trying to enjoy a bit of sun but at the same time being protected as well” (precontemplation) and remaining fashionable, “It just doesn’t look as nice as your cap, it really just isn’t a fashion statement” (precontemplation). The single interviewee who identified as being in an action stage for this measure noted that he wore a wide-brimmed hat because he was bald and therefore required head coverage, and a baseball cap failed to provide neck coverage. This participant chose to wear his own wide-brimmed hat rather than that issued by RMG.
Several participants indicated that their attitude might change in response to sunburn, “If I got really badly burned, yeah, that would make a difference and I would definitely start wearing it” (contemplation) or skin cancer diagnoses, “A friend of mine was told that he had skin cancer a little while ago. Now it’s cleared up, but if you’d something like that you would definitely consider [wearing a wide brimmed hat]” (precontemplation). Furthermore, some indicated that attitude change might be possible if RMG was to introduce an attractive wide-brimmed hat, “If Royal Mail can produce something that is going to be better I think that the guys would maybe use it” (contemplation).
3.2.2. Normative Beliefs
There was a widespread view that RMG advocated the use of a wide-brimmed hat yet did so with a “light touch”, providing hats while leaving individuals to decide whether to put them into use, “They just provide it then it’s up to you to decide what to wear” (precontemplation). Many interviewees noted that RMG did not enforce its use, “They [RMG] would probably tell us we should be doing that but I think it’s one of those things that would slide. It’s not like they’re going to get on you about not wearing a wide brimmed hat” (precontemplation); “I know that RMG actually provides one of those so maybe they do expect us to wear them. It’s not really pushed onto you to wear it though. It is just available” (precontemplation). Although some interviewees suggested that they would be unwilling to wear a wide brimmed hat even if it were company policy to do so, the contrary view was also expressed, “If they made you wear one I suppose you’d do it wouldn’t you” (precontemplation), and there was also a view that if enforced, over time it would become a cultural norm, “If everybody started wearing them everybody would probably get over the embarrassment” (contemplation).
3.2.3. Control Beliefs
Across the stages, participants expressed the view that the wearing of a wide brimmed hat was within their control, “I could do it if I wanted to, just, nah” (precontemplation). Some in inaction stages noted that the wearing of a wide brimmed hat was difficult due to impracticalities such as catching on the strap of the mailbag when lifted over the head or blowing off in the wind. As one interviewee put it, “We did get them a couple of years ago; I wore it for a day or two until I walked into a doorframe. It covers your eye, so practically, no I wouldn’t wear one now” (precontemplation). Similarly, “They’re just annoying. It could be red hot but if it’s windy they just go everywhere” (precontemplation). Others noted that the hat tended to lose its rigidity when wet, making it impractical, “I did have one once, and it got rained on and just collapsed” (precontemplation); “They’re too floppy, as soon as you wash it or it gets wet it never recovers its shape” (precontemplation).
Several participants preferred to wear an RMG-issued baseball-style cap and take additional measures to cover the neck. For instance, “The hat that Royal Mail issued a couple of years ago was too awkward and not particularly comfortable, actually pretty uncomfortable. The baseball cap seems to be better for me. What I do to make up for the lack of coverage on the neck is to put sunblock on and I find that works 100%” (contemplation). Others used a baseball-style cap to protect the face while relying on shade provided by the upturned collar of a shirt to protect the neck, “It’s a good idea to keep the sun off the back of your neck; with a polo shirt you can put your collar up so it isn’t too much of a problem really” (precontemplation); “Just a peak cap would do me because your collar is high enough on your polo, so you can just flick it up if you need to” (precontemplation).
Some interviewees noted that wide brimmed hats were uncomfortable during hot weather, “[We] are out getting really hot in this weather, walking four or five hours, hats are really hard to wear” (precontemplation). Female participants noted that wide brimmed hats can be impractical on hot days for those with long hair: “When it’s warm we girls would tend to wear our hair up and with that floppy hat it’s just not practical, it gets in the way. When you have your hair down it’s so warm you just want it up and out of the way. So that’s why [I don’t wear one], it’s not practical” (precontemplation). Some in the inaction stages indicated that if RMG introduced a more comfortable and practical wide brimmed hat, they might be more inclined to use this measure. These interviewees also indicated that they would be more likely to use the hat if it were administered to all employees by default, “If somebody got me one I would probably think about it” (contemplation).